In his letter to the FTC, Grassley wrote that if true, these practices undermined efforts by Congress to lower the cost of, and increase access to, healthcare for millions of people across the country.

The settlement by HealthCare Partners Holdings LLC which was acquired by DaVita group in 2012 is believed to be the largest to date involving allegations that some Medicare Advantage plans exaggerate how sick their patients are to inflate government payments.

According to the released report, the companies charged the state of Ohio 8.8% more than they paid to pharmacies to fill prescriptions. The companies kept the more than $224 million difference between what they charged the state and paid for the drugs.

Key Benefit Administrators claims Teladoc overcharged them and then tried to structure the refund to reflect favorably on its books. Much of the complaint focuses on Teladoc’s billing arrangement. Rather than, pay a “per employee per month” (PEPM) charge, Teladoc proposed a new model in which it would bill KBA at the beginning of each month for telemedicine services it expected to provide.

Hospitals, physicians, insurers and several other groups including the AMA are taking sides with the Affordable Care Act in its latest legal struggles. They argued that Republican attorneys general lacked standing because they no evidence that their states had suffered harm or injury from the ACA.

A class action suit against Express Scripts has been dismissed by a New York Judge a year after dismissing an earlier version of the case. It was alleged by TIAA that PBM misled investors about its decaying talks with Anthem. The deal’s fallout made PBM hold discussions with Cigna

It’s possible to create and develop your data models and algorithms without seeking the help of outside companies or vendors. With some hard-work and the right people in place, the algorithms or data models could be developed in-house

A research by KLAS to track changes in electronic medical records (EMR) provider market share in acute care hospitals discovered that smaller hospitals are seeking innovative IT solutions that would meet their needs on a tight budget, with the contracts making an impact on the EMR market